Basic Information
| Provider Information | |||||||||
| NPI: | 1356893150 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERDOMO | ||||||||
| FirstName: | MARTIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PR2 KM 2.2 KENNEDY AVE | ||||||||
| Address2: | MARGINAL JOHN F KENNEDY | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009360000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875223601 | ||||||||
| FaxNumber: | 7875223609 | ||||||||
| Practice Location | |||||||||
| Address1: | PR-2 KM 2.2 KENNEDY AVE | ||||||||
| Address2: | MARGINAL JOHN F KENNEDY | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009360000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875223601 | ||||||||
| FaxNumber: | 7875223609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2016 | ||||||||
| LastUpdateDate: | 10/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 4262 | PR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.